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I hope we’ll be hearing a lot more about this from Allyson Schwartz’s primary challenger, Nate Kleinman.

Schwartz has been one of the loudest opponents of any effort to reduce the price of medical care, and now it looks like she will vote with the House Republicans to kill IPAB – the most important cost-control provision in the Affordable Care Act.

There are two competing ways to reduce Medicare costs. Republicans want to do it by turning Medicare into a voucher program – they want to give you a coupon that pays for less and less care over time, without doing anything to try to bring down the actual price of medical treatment.

That is the reason our health care costs are so high – because our doctors and hospitals just charge much higher prices than in other countries.

Obama and most Democrats want to use Medicare’s monopsony power (like a monopoly, but on the buyer side) to push down the actual prices – paying less to providers. The Affordable Care Act created an Independent Payment Advisory Board tasked with lowering Medicare payments to providers without cutting benefits.

Obviously health care providers, like the big hospitals in Schwartz’s district, hate this idea, and they’ve enlisted all Republicans and a handful of Democrats to kill it, and pave the way for something like a RyanCare plan that does not try to bring down prices, and just gives you less and less benefits over time.

Allyson Schwartz says she opposes RyanCare, but by voting with the Republicans to kill IPAB, she makes it much more likely that we get ever-shrinking vouchers instead of real cost control.

So if this was a precipitant for Mr. Kleinman to challenge Congresswoman Schwartz, I suppose we should be going after the likes of Chaka Fattah and Barney Frank, as well.

You might have noticed that American hospitals are closing their doors and merging. I don't know of many in the 13th that are raking in money, and I refuse to believe that hospitals are at the root of the high costs of care in the U.S. Rather, hospitals might be *a* proximate cause, but this is due largely to the exorbitant costs of emergency and specialty care. By allowing universal access to primary care (something Schwartz championed in PPACA), there will be lessened demand for much more costly hospital care, and better health outcomes overall. The stakeholder in the health care debate that is actually banking inordinate profits is the private insurance industry. If lowering Medicare reimbursement rates is the fix to this problem, why doesn't CMS take it upon itself to do just that?

So if this was a precipitant for Mr. Kleinman to challenge Congresswoman Schwartz, I suppose we should be going after the likes of Chaka Fattah and Barney Frank, as well.

You might have noticed that American hospitals are closing their doors and merging. I don't know of many in the 13th that are raking in money, and I refuse to believe that hospitals are at the root of the high costs of care in the U.S. Rather, hospitals might be *a* proximate cause, but this is due largely to the exorbitant costs of emergency and specialty care. By allowing universal access to primary care (something Schwartz championed in PPACA), there will be lessened demand for much more costly hospital care, and better health outcomes overall. The stakeholder in the health care debate that is actually banking inordinate profits is the private insurance industry. If lowering Medicare reimbursement rates is the fix to this problem, why doesn't CMS take it upon itself to do just that?

The focus on private insurers as the villain in the health care reform debate was useful politics, but was fundamentally mistaken as a theory of why our health care system is so expensive. Providers are driving the higher costs. We pay more per unit of care than all other countries, because other countries have single payer systems that use price controls to hold down the cost of care, and thus the insurance that pays for the care. Private insurance is more expensive than Medicare because their risk pools are smaller. They are smaller "payers". The advantage of a single-payer system is that there's one government payer who can dictate prices to providers. Medicare is the closest thing we have to a single payer, and we should be trying to increase its market share so that it can push down prices. Those are the two options: price controls or benefit cuts. Republicans and Allyson Schwartz and the other Hospital Democrats don't want to control prices, so they're going to stick us with RyanCare's benefit cuts.

Providers in many other countries make much more than those in the U.S. My point is that there is only so much money going into the system to be divided among insurance companies, practitioners and hospitals and drug companies. Setting aside the superprofits achieved by pharma from the sale of patented drugs, the only group among these that's really thriving is insurance. There is no telling what effect IPAB could have on providers in the 13th, and as far as I know, there is no legislative check on IPAB's decisions. I find it strange that this is the panacea being put forth by the candidate who purportedly loves Occupy-style democracy and wants government back in the hands of individuals, given that IPAB would take control over Medicare firmly out of the hands of anyone elected to represent them.

One of the biggest problems with Medicare is that members of Congress, not medical professionals, have the ultimate say over reimbursement rates. Commenter Charles has been using a sleight-of-hand argument in asking why CMS doesn't implement their reimbursement recommendations. The reason is that Congress always ignores CMS's recommendations. Everybody likes the idea of better reimbursement criteria and "cost control", but nobody likes the idea of providers in their own district getting less money, so CMS always gets ignored. It's a classic collective action problem. The solution is to take the power over reimbursement rates away from Congress and give it to medical professionals.

I agree that pharma patents are a huge problem, and having a private insurance industry is wasteful since we could just have one government insurer. But the biggest problem is that the stuff insurance pays for is getting more expensive. We need to pay our providers what other countries pay their providers.

Just to clarify, I believe you're talking about MedPAC rather than CMS. The Commission is the body charged with making reimbursement policy recommendations to Congress. IPAB has never been one of them.

IPAB was strongly opposed by the vast majority of House Democrats – including liberal icons like Barney Frank – in 2009. It is a flawed policy that was advanced by moderate Democrats in the Senate from rural areas with healthy, middle-class populations. These cuts would hit vulnerable urban beneficiaries like many in Philadelphia who, as a result of socioeconomic factors, incur disproportionate costs to the Medicare program. Punishing those who care for these patients through cuts is not the answer. Neither are vouchers. There are many ideas under discussion for fundamental changes in the way we pay health care providers to reward efficiency without threatening access or quality.

Charles, please check the record, IPAB was never "opposed by the vast majority of House Democrats", only 17 Dems including Rep. Schwartz signed on for its repeal, so I'm not sure where you got that notion. Additionally, IPAB was championed by the President as a main cost-cutting mechanism, helping its passage along during a time when the cost of such social policy plans were met with much resistance on both sides of the aisle. And these cost cutting measures wouldn't "hit vulnerable urban beneficiaries", again, I don't know where you got that. And finally, in response to the implication by MontcoDem that Nate's support of IPAB is somehow against his democratic ideals, the panel would only be granted power to cut costs if Congress is unable to take action (so it is a last resort), something it has demonstrated time and again over the years. There's a reason their approval rating is around 10%. It's good that we're all talking about these things but we would be better served if the actual bill and available information was read by everyone before assumptions and accusations are made.

Right… since the bill has not yet come to the floor, however, it's a little difficult to determine the vote count. I would note that Ranking Member Pallone, member of the Congressional Progressive Caucus, voted in favor of HR 452 in the Energy & Commerce Health Subommittee last week. Stay tuned for additional Democratic votes in support of the bill this week in the full Committee mark-up. It is a political risk to admit that an otherwise transformational law that will benefit millions Americans has its imperfections. Democrats willing to stand up for access to care over flawed attempts to cut spending are carrying the torch for the progressive ideology on this issue.

Charles, please check the reocrd, IPAB was never “opposed by the vast majority of House Democrats”, only 17 Dems including Rep. Schwartz signed on for its repeal, so I’m not sure where you got that notion. Additionally, IPAB was championed by the President as a main cost-cutting mechanism, helping its passage along during a time when the cost of such social policy plans were met with much resistance on both sides of the aisle. And these cost cutting measures wouldn’t “hit vulnerable urban beneficiaries”, again, I don’t know where you got that. And finally, in response to the implication by MontcoDem that Nate’s support of IPAB is somehow against his democratic ideals, the panel would only be granted power to cut costs if Congress is unable to take action (so it is a last resort), something it has demonstrated time and again over the years. There’s a reason their approval rating is around 10%. It’s good that we’re all talking about these things but we would be better served if the actual bill and available information was read by everyone before assumptions and accusations are made.